Niehues R, Schlüter S, Kramer A, Klein R M, Strauer B E, Schaal K P, Horstkotte D
Klinik für Kardiologie, Pneumologie und Angiologie, Universität Düsseldorf.
Dtsch Med Wochenschr. 1996 Nov 8;121(45):1390-5. doi: 10.1055/s-2008-1043158.
A 62 year-old male patient developed malaise, unproductive cough and high temperature (39.5 degrees C) during immunosuppressive therapy with methylprednisolon and cyclosporin A six months after kidney transplantation for glomerulonephritis.
Clinical examination revealed an endophthalmitis and chest X ray a left-sided lobar pulmonic infiltration. Computed tomography and magnetic resonance imaging examination performed because of recurrent petit-mal-convulsions demonstrated multiple intracranial infiltrations. Transoesophageal echocardiography revealed floating vegetations up to 8 mm in diameter predominantly attached to the aortic valve. A total of 39 consecutive blood cultures drawn during several days remained sterile. However, Nocardia asteroides (Biovar A1) was isolated from a small cutaneous tumor excised from the right thigh.
After initiation of a specific antibiotic treatment with imipenem/cilastatin (each 1 g three times daily), and doxycyclin (100 mg twice daily), computed tomography and magnetic resonance imaging showed a reduction in size and number of the intracranial infiltrations. Neurological symptoms were progressive despite maximal anticonvulsant therapy. The patient died 83 days after hospital admission from an epileptic state resistant to therapy.
Though nocardiosis is still rare, it should early be included in the differential diagnosis of infections in immunocompromised patients to allow timely diagnosis and therapy.
一名62岁男性患者，因肾小球肾炎接受肾移植6个月后，在使用甲泼尼龙和环孢素A进行免疫抑制治疗期间出现不适、干咳和高热（39.5摄氏度）。
临床检查发现眼内炎，胸部X线显示左侧大叶性肺浸润。因反复出现失神小发作而进行的计算机断层扫描和磁共振成像检查显示多处颅内浸润。经食管超声心动图显示直径达8毫米的浮动赘生物，主要附着于主动脉瓣。连续数天采集的39份血培养物均无菌生长。然而，从右大腿切除的一个小皮肤肿瘤中分离出星形诺卡菌（生物变种A1）。
开始使用亚胺培南/西司他丁（各1克，每日三次）和多西环素（100毫克，每日两次）进行特异性抗生素治疗后，计算机断层扫描和磁共振成像显示颅内浸润的大小和数量有所减少。尽管进行了最大剂量的抗惊厥治疗，神经症状仍在进展。患者入院83天后死于抗治疗的癫痫状态。
虽然诺卡菌病仍然罕见，但应尽早将其纳入免疫功能低下患者感染的鉴别诊断，以便及时诊断和治疗。
